Review by insurance that grants approval for reimbursement of a health care service.

2.

_______ High Deductible Contract

B.

Reimbursement methods based on the number of individuals covered by the contract.

3.

_______ Capitation

C.

Patient insurance may stipulate a percentage of charges a patient must pay after reimbursement.

4.

_______ Health Savings Accounts

D.

Subscriber responsible for a large amount of health care costs during the year.

5.

_______ Copays and Deductibles

E.

Medicare regulations state a provider must refund a payment received from a patient for a service that is deemed by Medicare as unnecessary, experimental, or unapproved, unless the patient agrees to pay the provider in advance.

6.

_______ Gag Clause

F.

Gives tax-favored treatment for expenditures on health care cost. Enrollees of high deductible plans can save the money needed for health services.

7

_______ Preauthorization

G.

Special clauses in contract that stipulate additional coverage over and above the standard contract.

8.

_______ Coinsurance

H.

Amount of out-of-pocket costs a subscriber must pay each year for provider visits or procedures.

9.

_______ Rider

I.

Prevent providers from discussing all treatment options with patients; banned by Medicare and many states.

10.

_______ Medically necessary

J.

Subscribers can choose in-network or out-of-network provider.

Part B: It is no secret that patients ask many questions about their insurance. In fact, many will assume the doctor’s office knows everything about insurance. Understanding various insurance structures will give you the tools needed to assist your patients. In the following scenarios, you are answering the phone at a health care center and patients are calling with insurance questions.

Write a 90- to 175-word response to each of the following questions. Format your answers according to APA guidelines and cite any sources accordingly.

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